抗菌药物使用与鲍曼不动杆菌耐药性变迁的相关性分析

Correlation between Antimicrobial Usage and the Resistance of Acinetobacter Baumannii

目的:分析抗菌药物使用频数(DDDs)和使用强度(AUD)与鲍曼不动杆菌(Ab)耐药率变迁的相关性,为临床治疗选择抗菌药物提供参考。方法:回顾性收集统计2016年1月1日至2020年12月31日宜春市人民医院住院患者标本中分离的鲍曼不动杆菌的耐药数据和抗菌药物DDDs及AUD数据,采用Spearman相关性统计方法分析其之间的关系。结果:鲍曼不动杆菌对氨苄西林舒巴坦、头孢哌酮舒巴坦、头孢噻肟、头孢他啶、头孢吡肟、亚胺培南、左氧氟沙星、环丙沙星的耐药率与碳青霉烯类、糖肽类的DDDs和AUD正相关(P<0.05),而与大环内酯类的AUD负相关(P<0.05)。其中,对头孢他啶和头孢吡肟的耐药率还与喹诺酮类的DDDs和AUD正相关(P<0.05),而对其余抗菌药物的耐药率仅与喹诺酮类的AUD正相关(P<0.05)。对阿米卡星的耐药率与氨基糖苷类的DDDs和AUD正相关(P<0.05),与一二代头孢菌素和四环素类的DDDs和AUD负相关(P<0.05)。对多西环素的耐药率与一二代头孢菌素、碳青霉烯类、喹诺酮类、四环素类和糖肽类的DDDs和AUD正相关(P<0.05),而与氨基糖苷类的DDDs和AUD负相关(P<0.05)。对复方磺胺甲噁唑的耐药率与一二代头孢菌素和四环素类的DDDs和AUD正相关(P<0.05),与氨基糖苷类的DDDs和AUD负相关(P<0.05)。结论:鲍曼不动杆菌耐药性变迁与抗菌药物的使用关系广泛,尤其是碳青霉烯类和喹诺酮类药物的使用将诱导多重耐药鲍曼不动杆菌产生。

Objective:To retrospectively analyze the correlation between antimicrobial use frequency(DDDs)and use intensity(AUD)and the resistance rate of Acinetobacter baumannii,so as to provide reference for clinical treatment.Methods:The drug resistance data of Acinetobacter baumannii and antimicrobial usage from January 1,2016 to December 31,2020 were collected from inpatients in Yichun People's Hospital,and the correlation among them were analyzed by the Spearman correlation statistical method.Results:The resistance rates of Acinetobacter baumannii to ampicillin sulbactam,cefoperazone sulbactam,cefotaxime,ceftazidime,cefepime,imipenem,levofloxacin and ciprofloxacin were positively correlated with DDDs and AUD of carbapenems and glycopeptides(P<0.05),and negatively correlated with AUD of macrolides(P<0.05).The resistance rates to ceftazidime and cefepime were also positively correlated with DDDs and AUD of quinolones(P<0.05),while the resistance rates to other antimicrobials were only positively correlated with AUD of quinolones(P<0.05).The resistance rate to amikacin was positively correlated with DDDs and AUD of aminoglycosides(P<0.05),and negatively correlated with DDDs and AUD of the first and second generation of cephalosporins and tetracyclines(P<0.05).The resistance rate to doxycycline was positively correlated with DDDs and AUD of the first and second generation of cephalosporins,carbapenems,quinolones,tetracyclines and glycopeptides(P<0.05),and negatively correlated with DDDs and AUD of aminoglycosides(P<0.05).The resistance rate to trimethoprim-sulfamethoxazole was positively correlated with DDDs and AUD of the first and second generation of cephalosporins and tetracyclines(P<0.05),and negatively correlated with DDDs and AUD of aminoglycosides(P<0.05).Conclusion:The change of resistance of Acinetobacter baumannii is widely related to the use of antimicrobials,especially the use of carbapenems and quinolones will induce the production of multi drug resistant Acinetobacter baumannii.